Value of self-monitoring in type 2 diabetes queried
Eugene Bochkarev/Dreamstime.com
Blood glucose monitoring by people with diabetes may not lead to
improved HbA1c |
Self-monitoring of blood glucose by patients with reasonably well controlled type 2 diabetes has been questioned in a study published on BMJ
Online First (25 June 2007).
Researchers compared three strategies in 453 patients with non-insulin
treated type 2 diabetes and a mean HbA1c level of 7.5 per
cent.
Patients received:
• standardised usual care with measurements of
HbA1c carried
out by a health professional every three months
• usual care plus self-monitoring
of blood glucose with advice to contact their doctor for interpretation
of results
• or usual care plus self-monitoring of blood glucose and training
on how to interpret and apply the results themselves.
They found that,
at 12 months, there was no significant difference in HbA1c levels between
the three groups (P=0.12).
Patients allocated to the first self-monitoring group (with doctor input)
were more likely to continue using the meter than those allocated to
the second self-monitoring group. The researchers highlight that previous
trials have found that trying to understand results when they do not
fall into a pattern may cause frustration or that interest may wane when
results become predictable.
An increased rate of recording of hypoglycaemic episodes was observed
in those patients monitoring their own glucose but this may be because
of an increased awareness of low blood glucose rather than a true biochemical
difference, the researchers suggest.
A small but significant improvement in total cholesterol levels was also
observed in patients in the self-monitoring groups. The researchers propose
that this could be due to an increased intensity of self-management,
possibly leading to better dietary adherence and compliance with lipid
lowering therapy.
“Routine self-monitoring of blood glucose for patients with reasonably
well controlled non-insulin treated type 2 diabetes seems to offer, at
best, small advantages; is not well accepted; and the cost, effort, and
time involved in the procedures may be better directed to supporting
other health related behaviours,” say the researchers. They suggest
that current guidelines for use of self-monitoring in these patients
should be reviewed. |
The
Pharmaceutical Journal
Acrobat
Reader